Provider Demographics
NPI:1174514699
Name:ANDERSON, ANN M (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:FRIENDSHIP
Mailing Address - State:WI
Mailing Address - Zip Code:53934-0010
Mailing Address - Country:US
Mailing Address - Phone:608-339-3326
Mailing Address - Fax:608-339-6057
Practice Address - Street 1:302 WEST LAKE ST
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:WI
Practice Address - Zip Code:53934
Practice Address - Country:US
Practice Address - Phone:608-339-3326
Practice Address - Fax:608-339-6057
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI01E5OtherJOHN DEERE
WI1002627OtherTOUCHPOINT
WI12579OtherDEAN
WI39080723691OtherUNITY
WI43889700Medicaid
WI500005455OtherRAILROAD MEDICARE
WI39080723691OtherUNITY
S25806Medicare UPIN